Key result
Onset seizures in aSAH lack overall link to poor outcomes except in patients under 51.
Why the study?
There is no consensus on the causal background and clinical value of seizures occurring at the onset of aneurysmal subarachnoid hemorrhage.
Do seizures at the onset of aneurysmal subarachnoid hemorrhage predict poor clinical outcomes and in-hospital mortality?
Observational (n=984)
No
Do seizures at the onset of aneurysmal subarachnoid hemorrhage predict poor clinical outcomes and in-hospital mortality?
Odds Ratio: 1.39 (95% CI 0.9–2.15)
p-value: p=0.131
Seizures at the onset of aneurysmal subarachnoid hemorrhage are associated with early brain injury severity and independently predict poor functional outcome specifically in younger patients.
Onset seizures may flag higher risk in younger aSAH patients; leaves open whether they are causal or surrogate markers of injury severity.
OBJECTIVE: Seizures at the onset (SAO) of aneurysmal subarachnoid hemorrhage (aSAH) occur in up to one of every five cases. To date, there is no consensus on causal background and clinical value of these early bleeding-related seizures. This study aimed to analyze the predictors and the impact of SAO in aSAH. METHODS: All aSAH patients from the institutional observational cohort (01/2003-06/2016) were retrospectively reviewed. Patients' charts and emergency protocols from first responders were screened for the occurrence of seizures in the first 24 h after aSAH. Patients' baseline characteristics and occurrence of post-hemorrhagic complications were analyzed. Outcome endpoints included in-hospital mortality and poor outcome at 6-month follow-up (modified Rankin Scale > 3). RESULTS: Of 984 patients included in the final analysis, SAO occurred in 93 cases (9.5%) and were independently associated with younger age (< 51 years, p < 0.001), WFNS grade ≥ 4 (p < 0.001), aneurysm characteristics (location at the proximal branch of the anterior cerebral artery [p = 0.037] and irregular sac [p = 0.019]) and admission body temperature > 38.3 ℃ (p = 0.008). There was an association between SAO and early complications (early infarcts [p = 0.004] and primary decompressive craniectomy [p = 0.024]). Only in the subgroup analysis restricted to the younger individuals, SAO independently predicted poor outcome of aSAH (p = 0.002). SIGNIFICANCE: Onset seizures following aSAH are rare and most likely related to the severity of early brain injury. Particularly, younger individuals are not only at higher risk for SAO, but are also prone to poor outcome in case of aSAH accompanied with SAO. TRIAL REGISTRATION NUMBER: German clinical trial registry (DRKS, unique identifier: DRKS00008749, 06/09/2015).
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Oppong et al. (2020) conducted an observational in Aneurysmal subarachnoid hemorrhage (aSAH) (n=984). Seizures at the onset (SAO) vs. No seizures at onset was evaluated on Poor outcome (modified Rankin Scale > 3) at 6-month follow-up (OR 1.39, 95% CI 0.9-2.15, p=0.131). Seizures at the onset of aneurysmal subarachnoid hemorrhage occurred in 9.5% of patients and did not significantly impact overall functional outcome, though they independently predicted poor outcome in patients younger than 51 years.
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